MEDICARE: LEO T LEINS DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	H 01 1 05392	CO

General Provider Information

NPI Number	:	1932292059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEO T LEINS DDS PC

Provider Business Mailing Address
First Line	:	9695 SOUTH YOSEMITE
Second Line	:	SUITE 327
City	:	LONE TREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	303-671-0761
Fax Number	:	720-881-7446

Provider Business Practice Location Address
First Line	:	9695 SOUTH YOSEMITE
Second Line	:	SUITE 327
City	:	LONE TREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	303-671-0761
Fax Number	:	720-881-7446

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. KELLY LEINS
Credential	:
Telephone Number	:	303-671-0761

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	06/11/2013

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